Exactly What A Top Derm Does To Keep Her Hyperpigmentation Under Control

Kim Nichols, M.D. is a 41-year-old dermatologist with melasma and combination skin. This is how she keeps her tone even and her complexion balanced.

A.M.

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Step 1. Melasma is a form of hyperpigmentation that lives on and beneath the skin's surface. It's caused by hormones, and it often appears first during pregnancy, but mine has lasted eight years post-pregnancy. After my morning workout, I use cleansing wipes to remove oil and then apply an antioxidant serum; it neutralizes free radicals before they can trigger the pigment cells in my skin.Buy it:Cetaphil Gentle Skin Cleansing Cloths, $9, amazon.com; Neocutis Reactive Anti-Oxidant Serum, $90, amazon.com

Step 2. Even though hormones, and not the sun, brought on my melasma, UV exposure can still darken them at the surface—the same way the sun darkens freckles in the summer—so I'm careful to apply a broad-spectrum sunscreen every morning. I prefer physical formulas with titanium dioxide or zinc oxide because they create a strong block on my skin. This one has a bit of a tint so it won't leave behind any chalky white film.Buy it: Elta MD UV Daily Tinted Broad-Spectrum SPF 40, $18, amazon.com

P.M.

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Step 1. I have combination skin, meaning that my T-zone is oily and my cheeks are dry. I like a foaming cleanser for anyone with this skin type because it can bust through oil in the parts that need it but isn't harsh on the sensitive patches. A few times a week, I'll rub it on with a washcloth to resurface the top layer of my skin. In general, this manual exfoliation tends to be more foolproof than chemical exfoliation because it's more predictable.Buy it: Clarins Gentle Foaming Cleanser, $25, at Sephora

Step 2. Following my cleansing regimen, I apply a high dose of hydration. I'll start with a serum infused with B vitamins, which deeply moisturize and get rid of surface dead skin cells, allowing the rest of my products to better penetrate and work. Then I'll use an occlusive cream—this traps not only moisture but the active ingredients (mine has antioxidants and vitamin E) into the skin.Buy it: SkinCeuticals Hydrating B5 Gel, $82, skinceuticals.com; Avon Anew Ultimate Supreme Advanced Performance Creme, $50, avon.com

WHEN NEEDED

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If my dark patches are very noticeable, I'll use a 4 percent hydroquinone cream. It's a prescription lightener that works by inhibiting the melanin-producing enzyme called tyrosinase. I normally use it only on my most affected areas rather than the whole face. It's important to note that everyone's skin won't react the same way to this product—I always monitor my patients closely when starting them on hydroquinone because it can dry and irritate skin. (Speed up your progress to your weight loss goals with Women's Health's Look Better Naked DVD.)

ONCE A MONTH

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I'll go get a chemical peel at my dermatologist's office. My favorite is made with resorcinol and lactic acids; these are much less irritating agents than glycolic acid, which is found in most in-office peels. It gets rid of most of my problem, but the areas around my mouth are affected at the deeper, epidermal layer that the peel can't reach.

TWO TIMES A YEAR

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For the deeper melasma, I like to do PRP Microneedling, a.k.a. the "vampire facial" (starting at $800). Your derm draws your blood, separates the stem-cell-rich platelets, and microneedles your skin, creating tiny channels. Then she paints the platelets onto your face so they can penetrate to skin's deeper levels. Research shows that the growth factor known as TGF-ß1 (found in platelets) could inhibit melanin production at the cellular level. In doing so, it also teaches misfiring pigment cells to work properly.

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SLEEP IT OFF

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I go to bed around 10 nowadays because quality REM sleep occurs earlier in the night. And the more restorative your sleep, the less chance your cortisol levels will rise. When those peak, you can get cellular damage. I could be doing everything right to treat my melasma, but the high cortisol could make my pigment cells produce more melanin and undo all that good. No thanks!

This article originally appeared in the Jan/Feb 2017 issue of Women's Health. For more smart beauty and fashion fixes, pick up the issue on newsstands now.

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